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Advancements in laparoscopic surgery have led to the development of techniques that allow for multiple procedures to be performed through a single port. This approach minimizes patient trauma, reduces postoperative pain, and shortens recovery time. Here, we discuss the feasibility and technique of performing laparoscopic cholecystectomy, tubal ligation, and appendectomy in the same patient using a single-port approach.
Patient Selection
Patient selection is critical for the success of combined procedures. Ideal candidates are those who require simultaneous intervention for gallbladder disease, permanent sterilization, and appendicitis or prophylactic appendectomy. Contraindications include extensive adhesions from previous surgeries, severe obesity, or conditions that limit the patient's ability to tolerate pneumoperitoneum.
Preoperative Preparation
Assessment: Comprehensive preoperative evaluation to confirm the necessity of all three procedures.
Consent: Detailed discussion with the patient regarding the risks, benefits, and the combined surgical plan.
Anesthesia: General anesthesia with endotracheal intubation.
Surgical Technique
Port Placement
A supraumbilical port is utilized due to its central location, providing optimal access to the gallbladder, fallopian tubes, and appendix. A single-port device or a multi-channel trocar can be used.
Step-by-Step Procedure
Establishing Pneumoperitoneum:
Insufflate the abdomen with CO2 to achieve a pressure of 12-15 mmHg.
Insert the single-port device supraumbilically.
Laparoscopic Cholecystectomy:
Identification and Dissection: Using a 30-degree laparoscope, identify the cystic duct and artery. Perform the dissection using standard laparoscopic instruments introduced through the single-port device.
Clipping and Division: Clip and divide the cystic duct and artery.
Gallbladder Removal: Separate the gallbladder from the liver bed and extract it through the single-port device.
Laparoscopic Tubal Ligation:
Visualization: Rotate the laparoscope to visualize the fallopian tubes.
Ligation: Grasp the fallopian tube with a laparoscopic grasper and apply bipolar electrocautery or use a Filshie clip for occlusion. Repeat on the contralateral side.
